Background/Objectives: Oral diseases represent a major public health challenge in Africa, considering socioeconomic disparities and limited healthcare access. This systematic review aimed to comprehensively analyze the oral health status, conditions, and associated socioeconomic and cultural associated factors in North and West African regions. Methods: A systematic search was conducted in PubMed, Web of Science, and Scopus for cross-sectional studies. Using the CoCoPop framework, 19 studies were selected and evaluated for risk of bias using the JBI critical appraisal tool. Results: The findings reveal a substantial burden of untreated pathology, with localized caries prevalence reaching 74% in children. Periodontal health is consistently compromised in adults, characterized by high levels of calculus and gingival bleeding. Self-reported data highlight a symptom-driven culture, where lower-socioeconomic-status (SES) households rely on traditional remedies or emergency extractions due to economic and geographic barriers. Conclusions: Oral health in North and West Africa is characterized by profound inequalities. Current systems fail to reach vulnerable populations, emphasizing the urgent need for a structural shift toward integrated, equity-oriented primary care models that prioritize prevention over reactive, extraction-based treatments.